Abstract
BACKGROUND: The efficacy and safety of tailored pulmonary vein isolation (PVI) guided by either left atrial wall thickness (LAWT) or bipolar voltage remain unclear. OBJECTIVE: The aim of this prospective study was to evaluate the efficacy and safety of each ablation strategy. METHODS: We conducted a prospective analysis of 97 patients with non-valvular atrial fibrillation (AF) who underwent an initial RF catheter ablation procedure known as an extensive encircling PVI. Fifty patients underwent PVI using a wall thickness (WT)-guided approach using ADAS 3D software and 47 patients using a voltage-guided approach. In each strategy, high-power short-duration (HPSD) ablation was applied to regions with increased LAWT or elevated bipolar voltage, respectively, while very high-power short-duration (vHPSD) ablation was delivered to the remaining regions. RESULTS: The first-pass PVI rate tended to be higher in the WT-guided group compared to the Voltage-guided group (43 [86%] vs. 34 [72%], p = 0.09), and the incidence of acute PV reconnection (APVR) tended to be lower (5 [10%] vs. 11 [23%], p = 0.07). The proportion of patients with PV gaps (defined as the combined occurrence of first-pass failure and/or APVR) was significantly lower in the WT-guided group (10 [20%] vs. 18 [38%], p = 0.04). The multivariable-adjusted analysis demonstrated that WT-guided ablation was significantly more effective than Voltage-guided ablation in preventing PV gaps. Both ablation strategies were performed without any procedural complications. CONCLUSIONS: WT-guided ablation was associated with a significantly lower incidence of PV gaps than a conventional bipolar voltage-guided strategy.